Contact Information

Questions about Health Benefit Programs? Call the Health Care Access Line (831) 454-2515 or (831) 763-8568 Benefits Call Center: 1-888-421-8080 Serving ongoing Medi-Cal & Food Stamp clients Customer Service Guide - FAQ

	There are various financial assistance programs available to assist people who are in need of medical services and cannot afford to pay for them.  To receive most health benefits you must apply and be certified eligible. Call the contact numbers in the "Where to Apply" section of each program to see if you are eligible.

--- Access for Infants & Mothers (AIM) ---

--- California Children Services (CCS) Program ---

What services are offered?

• Diagnosis and treatment of CCS eligible conditions by CCS approved physicians and at CCS approved hospitals, Special Case Centers (SCC) and Medical Therapy Program (MTP).

• Provides medically necessary care and case management to infants, children, and adolescents meeting program eligibility requirements. These include physician services, hospitalization, occupational therapy, in-home nursing services, and supplies.

Children under 21 years of age who have medical and disabling conditions that meet CCS eligibility criteria.

Family income less than $40,000 (Annual, Adjusted Gross Income on State Tax Form) – OR – if out-of-pocket medical expenses for the qualified child are expected to be more than 20% of the families annual income. Services provided at a Medical-Therapy Unit (MTU) are exempt from financial eligibility requirements.

No.

Yes. (CCS only covers diagnosis and treatment of a child’s CCS eligible condition).

There may be an assessment and / or enrollment fee depending on income.

Is citizenship or legal residency required?

No. Must be a permanent resident of Santa Cruz County. If not a Santa Cruz County resident, may apply in County of residence.

Call Santa Cruz: (831) 454-2540 OR Watsonville: (831) 763-8900

• Residents of Monterey County ONLY!

• Be age 2 through 18 and not married;

• Not eligible for coverage under Medi-Cal or Healthy Families;

• Not enrolled under any private health care plan with coverage for preventative care;

• If school age, be enrolled and attending school;

• Each child in a family must be enrolled and the family’s income must meet specific guidelines.

No.

No.

No.

--- California Major Risk Medical Insurance Program (MRMIP) ---

Comprehensive health insurance for those who are unable to obtain coverage on the open market.

You cannot be eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease. (Being eligible for one part or the other is acceptable).

Medi-Cal beneficiaries are not prohibited from enrolling, but should carefully consider the cost of the MRMIP monthly subscriber contributions.

You must be unable to secure adequate coverage demonstrated by:

• Having been denied individual coverage within the previous 12 months.

• Having been involuntarily terminated for health insurance coverage within the previous 12 months for reasons other than nonpayment of premium or fraud.

• If you have been offered, in the previous 12 months, an individual, not a group, health insurance premium in excess of the Major Risk Medical Insurance Program subscriber rate for your first-choice participating health plan.

• If you are a member of a group of two or fewer (not including dependents) who has been denied health insurance coverage in the previous 12 months.

No.

No.

You cannot be eligible to purchase any health insurance for continuation of benefits under COBRA.

Varies according to individual health plan choice, age, and County of residence.

Is citizenship or legal residency required?

Must be California resident.

Where to apply?

Call: (800) 289-6574

Visit: www.mrmib.ca.gov/MRMIB/MRMIP.html

--- Child Health & Disability Prevention Program (CHDP) ---

• Regular complete health checkups and shots. (Based on age, entitled to 15 or more exams).

• Temporary Medi-Cal coverage up to 60 days for qualifying children.

What does a family need to bring to a CHDP visit to confirm eligibility?
Families with Medi-Cal insurance must bring their insurance cards. Families that have no insurance must complete and sign a form declaring their income at the visit.

Where can a child receive a CHDP examination?
Most pediatricians and many family practitioners are certified CHDP providers. Often physicians or clinics have nurse practitioners or physician assistants who are CHDP Examiners. Often, families can go to their child’s usual health care provider. Call your doctor’s office to find out if the office participates in the CHDP Program. If your doctor is not certified, click on County CHDP Providers to learn the locations of certified providers.

• All children and youth birth through 20 years of age who are certified as eligible to receive Medi-Cal.

• All children and youth birth through 18 years who do not have Medi-Cal but do meet the family income eligible levels described below.

• Any child attending a Head Start or State Preschool Program who meets income edibility.

Up to 200% of the FPL (see Income Eligibility Determination Table)

No.

Yes, if insurance plan does not cover Well-Child exam or immunizations.

No Cost.

No.

Schedule an appointment with a CHDP doctor. Call CHDP for a list of current doctors.

Santa Cruz: (831) 454-2560 OR Watsonville: (831) 763-8932

Click here to visit the CHDP Web Page

What services are offered?

• Comprehensive family planning services including contraceptive services.

• Pregnancy testing, female and male sterilization, limited infertility services.

• Reproductive health counseling and education related to contraceptive methods.

• Counseling and education related to contraceptive methods, screening for sexually transmitted infections, as well as breast and cervical cancer.

Women and men who are California residents.

Is there an income limit?

Up to 200% of the Federal Poverty Level (FPL).

Is there a property limit?

No.

Can services be received if there is other health insurance?

Yes, in the following instances:

• if they have Medi-Cal with an un met share of cost on date of service;

• if benefits do not cover family planning services;

• if the insurance requires a deductible that has not been met;

• f the client's use of their other coverage would create a barrier to access because of confidentiality.

No cost to patient.

Is citizenship or legal residency required?

Must be a California resident, but no citizenship requirement.

Where to apply?

At participating clinics and physician offices. Call 1 (800) 942-1054 for a listing.

Santa Cruz: (831) 454-2515 OR Watsonville: (831) 763-8568

Healthy Family web site: www.healthyfamilies.ca.gov/, www.mrmib.ca.gov

Assets cannot amount to more than $4,000 (excluding one house and one car).

CARE/HIPP supports participants to maintain their health insurance Coverage as they transition into Medi-Cal.

Comprehensive benefits are offered by each health plan. Subscribers make health plan choices based on cost, doctor/hospital network, level of co-payment, type of plan, and services offered by each. Additional dental plans are available.

Who can be covered?

Is there an income limit? 

No.

Is there a property limit? 

No.

Can services be received if there is other health insurance? 

No.

Where to apply? 

Call 1 (877) 735-5742.

• Comprehensive preventive care services, primary and specialty care.

• Medical office visits, vision care, dental care and mental health services

• Hospitalization and prescription medicines.

• Guide to MCAL Programs

Children up to their 19^th birthday.

Please visit the Champ-Net Online Eligibility Calculator for Medi-Cal/Healthy Families.

• Ages 0 to 1  At or below 200% of the Federal Poverty Level (FPL)

• Ages 1 to 6  At or below 133% of the FPL

• Ages 6 to 19 At or below 100% of the FPL

Please download the Champ-Net Online Income Calculation Worksheet in Adobe Acrobat PDF format.

Is there a property limit?

Yes, for full coverage. If not a legal resident, the person may be eligible for emergency services only.

• Comprehensive preventive care services, primary and specialty care.

• Medical office visits, vision care, dental care and mental health services.

• Hospitalization and prescription medicines.

Parents or caretakers and children up to their 21^st birthday.

Please visit the Champ-Net Online Eligibility Calculator for Medi-Cal/Healthy Families.

Free Medi-Cal is based on monthly income after allowances for child care and working expenses.

Families with income above these limits may have to pay a monthly share of cost for medical services. NOTE: Other rules may apply which might allow free Medi-Cal in some cases.

Please download the Champ-Net Online Income Calculation Worksheet  in Adobe Acrobat PDF format.

Yes, depending on family size:

Yes.

The family’s share of cost depends on the amount of monthly income over the income limits shown.

Yes, for full coverage.

If not a legal resident, the person may be eligible for emergency and pregnancy related services only.

Pregnancy and postpartum related services.

Pregnant women.

Is there an income limit?

At or below 200% of Federal Poverty Level (FPL).

Please visit the Champ-Net Online Eligibility Calculator for Medi-Cal/Healthy Families.

No.

Yes.

No cost.

No.

What is the eligibility criteria?

• Be disabled (according to federal standards);

• Have net income less than 250 percent of the federal poverty level for the working disabled person and his/her spouse (or parent(s) if the working disabled person is a child);

• Except for earnings, be eligible to receive Supplemental Security Income/State Supplementary Program (SSI/SSP) benefits; and

• Have countable resources less than or equal to $2000 for one person or $3000 if the working disabled person is married.

• An individual whose countable earned income is between $601 and $700 a month pays a monthly premium of $25.

• A couple whose countable earned income is between $601 and $700 a month pays a monthly premium of $40.

Can I receive personal assistance where I work?

Is citizenship or legal residency required?

• Comprehensive preventive care services, primary and specialty care.

• Medical office visits, vision care, dental care and mental health services.

• Hospitalization and prescription medicines.

Persons age 65 or older, legally blind or disabled by Social Security standards.

Free Medi-Cal is based on family size and income after allowances for health insurance and working expenses:

Persons with income above these limits have to pay a monthly share of cost for medical expenses.

Yes, depending on family size excluding principal residence and one car:

Yes.

The person’s share of cost depends on the amount of monthly income over the income limits shown above.

Is citizenship or legal residency required?

Yes, for full coverage.

If not a legal resident, the person may be eligible for emergency and pregnancy

related services only.

• Confidential medical services regardless of citizenship or immigration status, for the following:

1. Sexual assault

2. Pregnancy or family planning

3. Sexually transmitted diseases

4. Drug or alcohol abuse

5. Outpatient Mental Health

Persons under 21 years of age.

Please visit the Champ-Net Online Eligibility Calculator for Medi-Cal/Healthy Families.

Yes, one person, $600 a month to poverty level of 200%.

Please download the Champ-Net Online Income Calculation Worksheet in Adobe Acrobat PDF format.

Yes, $2,000 for one person.

Yes, other insurance does not have to be submitted.

No

• Skilled or intermediate Nursing Home and Convalescent Care as well as:

• Comprehensive preventive care services, primary and specialty care.

• Medical office visits, vision care, dental care and mental health services.

• Hospitalization and prescription medicines.

Persons in long term care facilities.

No, but recipients pay a monthly share of cost based on income after allowing a deduction for health insurance premiums and certain limited other expenses.

A spouse living at home, who is not on Medi-Cal, is allowed to retain over $2049 in family income per month. (Changes annually in January).

• Yes, the person in the nursing home may keep up to $2000 in property.

• A spouse living at home, who is not aided on Medi-Cal, is allowed to retain up to $84,120 in family assets.

Yes.

Patients pay a share of cost based on income after allowing a deduction for health insurance premiums and certain limited other expenses.

Yes, for full coverage.

If not a legal resident, the person may be eligible for emergency services only.

• Medical Office visits

• Prescription medicines

Who can be covered?
Persons who have been diagnosed with tuberculosis

Is there an income limit?  
At or below 200% of Federal poverty Level (FPL)

Please download the Champ-Net Online Income Calculation Worksheet in Adobe Acrobat PDF format.

Is there a property limit?
No

Can services be received if there is other health insurance?
Yes

How much does it cost?
No cost

Is citizenship or legal residency required?
No

• Part A (Hospitalization).

• Part B (Outpatient).

Persons eligible to receive Social Security or Railroad Retirement benefits due to age (65 years or older), disability or blindness who have received Social Security for at least 24 consecutive months, chronic renal disease.

No.

No.

Yes.

• Premium for Part B ($45.50 in 2000).

• Deductibles and co-payments.

(State will pay premium if beneficiary also receives Medi-Cal).

Yes.

Yes. www.medicare.gov or www.kff.org

Social Security Administration

Call toll free 1-800-772-1234 or

169 Walnut Ave., Santa Cruz

(831) 426-8111

-OR-

315 Main Street, Watsonville

(831) 722-7141

Medi-Cruz is a County of Santa Cruz managed health care program of last resort for the uninsured residents of Santa Cruz County. If you have private health insurance or are eligible for any other public health benefit program such as Medi-Cal (including PRUCOL) or Medicare you will be required to apply for them instead of Medi-Cruz.

What services are offered?

Medi-Cruz provides financial assistance for medical care for qualifying medical conditions, with limited pharmacy services based on the Medi-Cruz formulary (no generic drugs available), laboratory services, and x-ray services. 
Click here for services that are not covered by Medi-Cruz. Services are covered for a limited period specific to the treatment of the qualifying condition. Clients are expected to renew their application every two to three months depending on condition. 

• Primary care services must be obtained through a county health clinic (Emeline, Crestview or Coral Street). 

• All non-emergency specialty care outside the county clinics must be preauthorized by Medi-Cruz before services are received or they will not be covered. 

• Emergency care services are only covered for life, limb or sight threatening conditions and ONLY treated at Dominican or Watsonville hospitals. Out of county emergency department visits are not covered by Medi-Cruz. 

• Urgent Care at Palo Alto Medical Foundation Westside Clinic in Santa Cruz is available after 5:00 pm and on weekends and will be authorized with Medi-Cruz before treatment is given. Click here for more information on how to access this service.

What are the requirements for Medi-Cruz eligibility?

• Must be a current permanent resident of Santa Cruz County and provide proof of residency. 

• Must be between the ages of 21-65 years old. 

• Must have a current medical need that is covered by the program. These are subject to medical review. 
  Click here for list of medical conditions that are not covered by Medi-Cruz.

• Income cannot exceed 100% of the Federal Poverty Level guideline. An applicant with a monthly income over 100% Federal Poverty Limit ($903 for one person) is ineligible for Medi-Cruz.

• If you have private health insurance, Medicare or Medi-Cal you are not eligible for Medi-Cruz. 

• If you have a work-related injury you must file for worker’s compensation. 

• If you have an injury from an auto accident you must file a claim against your auto insurance and the other car owner’s insurance if appropriate. 

• Income tax returns, pay stubs, and bank account statements are required. 

• Eligibility workers will require verification of various information during the eligibility interview.

Are there Medi-Cruz co-pays or share of cost?
Medi-Cruz clients are required to pay:

• $12 co-pay for office visits

• $4 co-pay per prescription

• $45 Emergency Department visit co-pay

• $15 retinal eye scan co-pay, and others as approved by the Board of Supervisors.

Medi-Cruz clients might also have to pay a share-of-cost based on their income.

Medi-Cal is a statewide program to provide health coverage to people eligible for welfare benefits (have minor children in the home with an absent or incapacitated parent). It also is for people who are pregnant, under 21 or over 65, blind or disabled. Medi-Cruz is a local program to assist low-income individuals not eligible for Medi-Cal.

Are there citizenship or residency requirements?
A non-citizen applicant who does not have permanent residency status can apply for Medi-Cruz for primary care services ONLY (no emergency care). Regardless of citizenship/residency status, all applicants must be permanent Santa Cruz County residents

Where do I apply for Medi-Cruz?
You can for apply for Medi-Cruz at either of the two County health care clinics. Eligibility workers are available on a first come first serve basis. Click here for list of what verification documents you must bring in to apply.